Friday, April 13, 2012

Perils of Partnership

Before I begin, is anyone else flashing back to Data from "The Goonies?" "Pinchers of Peril! I've been saved by my Pinchers of Peril!" Anyone? Just me? Ah, well.

So, hi! I guess working full time, having a 4 year old and an almost 8 (!) year old in multiple activities, actually having a bit of a social life from time to time, and experiencing a intense sense of perfectionism if I do have the chance to write = no blogging for me.

We've been keeping very busy in the practice, and I have been navigating the waters of working with a large group of physicians, who may or may not treat patients in the exact way that I would treat them. Sometimes, with the really complicated patients, it almost feels like a game of "hot potato," with each physician hoping that they are not the one left "holding the bag," so to speak. I've never experienced this to such a degree, and there is one culprit who rises to mind beyond the others. It really ruffles my feathers, because I was always trained to do the best thing for the patient at the time, even if it was inconvenient for you, as the physician. I don't know if this is something that comes with being older in practice, more burnt out, perhaps? Being one of the junior partners, I can't help but feel, at times, that I am expected to "prove myself" to the more senior physicians in the group, by working just a little harder, complaining a little less, and dealing with getting the less than desirable cases. Kind of like being a glorified resident in many respects, and, let me tell you, that is d*mn tough to swallow. I also feel like I have to fight to bring up to date practice standards into the group managed patients, in this, I am having some success. This makes me happy because I think it benefits all of our patients. I am really hoping to adjust the way that we see patients while on-call, and have been hashing out some ideas to discuss in some upcoming meetings. I am happy to say my schedule is always full, but this is also daunting, because sometimes it is over-full (am I forever doomed to struggle with scheduling issues??), and I have had patients tell me it is difficult to get an appointment with me. I suppose all of these issues are swirling around my brain because in a few short months I will have the opportunity to become a full partner in the business, and I don't know what I don't know.

I'm excited and nervous to make the next big step in my career. Any wise words from those who have gone before me? Any questions to ask? Things I need to know before signing the dotted line?

Monday, January 23, 2012

Call Hierarchy of Needs

Now that I am not on call, all day, every day, I have found there is a certain behavioral pattern emerging on my call days. Something similar to Maslow's "Hierarchy of Needs," if you will.

First Goal - Be able to leave the hospital. You may laugh, but some days it is d*mn near impossible to do. I am always figuring and re-figuring in my head if I am going to be able to go home that night, or if I will wind up being stuck until after office hours the next day.
*First goal bonus if I am able to leave the hospital before my children's bedtime, so much the better to actually *see* them.

Second Goal - Shower at home. This seems like an odd one, I know, but I *hate* to shower in the hospital call room bathroom. It just is not the same, and it also slightly squicks me out. So if I achieve the first goal, I proceed immediately to goal number 2 as soon as I step foot in the door.

Third Goal - Eat. This rule has stayed the same since residency, "eat when you can."
*Third goal bonus if I actually getting to eat with my family or if I am not eating something like Ramen noodles.

Fourth Goal - Spend (somewhat) quality time with family (while obsessively keeping one eye on the computer L&D and ER census for potential roadblocks to goal number five).
*Fourth goal bonus if I am able to tuck my children in for bedtime and maintain a normal evening routine before getting called back to the hospital.

Fifth Goal - Sleep in my own bed. This one is a bit more elusive, as you can imagine.
*Fifth goal bonus if I get to sleep in my own bed *all night long.* (HA HA! Almost never happens.)
**Extra bonus if I get no pages while I am sleeping in said own bed, and wake up the next day frantically checking my pager to be certain the battery hasn't expired. (Again, elusive.)

Let's face it 5/5 goals happens once in a blue (full) moon. If I am able to achieve 4/5 goals, I feel pretty good about my call night. Satisfaction with the night decreases exponentially with each goal not met, naturally. Before I am derided, of course my ultimate and overriding goal is to provide quality care to my patients...and to sleep in my own bed. :)

**Cross -posted at Mothers In Medicine

Thursday, December 15, 2011

Well, tonight, thank G*d it's them, instead of you...

Does anyone else think that "Do They Know It's Christmas?" is the most uncharitable "charity" song around? It's downright laughable! So much so that I can't help but wonder if there isn't meant to be some sort of sardonic undercurrent beneath the song's earnestness. I mean, there's the most awful line, the line mentioned above, then, later on, we raise a glass to everyone, including "them, underneath that burning sun." ACK! Mix in some "clanging chimes of doom" and "bitter sting of tears" and, well, I admit it, I laugh my *ss off every time I hear this song. Probably not what "Band Aid" was going for, but I digress...

The true meaning for my title really pertains to how I feel when one of my partners is on call and it isn't me. I thank G*d it is them instead of me; because we have been insanely busy. Last call I delivered 8 babies in a 24 hour shift and admitted 9, 10, and 11 in labor. All of the rooms were full and our overflow was spilling into other rooms in the hospital. I have no idea what was going on nine months ago, people, but holy geez, the babies can stop coming any old time! We are T-minus 10 days from Christmas, and I didn't have enough to do, so I thought I'd sit down and let you know that I am still alive...and mostly well...and still wishing to win the lottery so I can become independently wealthy and play internet games and get buff and be the envy of the botox set (without using botox) and never, ever be on call again. I don't think Santa can deliver that kind of present, unfortunately.

This is going to be a magical Christmas for the Whoo family. Bean is 4 and CindyLou is 7 and both are steeped in the wonder and magic of the season. Their joy and wonder is palpable. I love it. It brings a tear to my eye. We only have so many magical Christmases with them, and I happen to be on call on Christmas-flipping-Eve this year. So my Christmas wish is that none of my patients get a special Christmas delivery in the wee hours of Christmas Day morning, so I don't have to miss out on the magic this year...hopefully Santa can manage that. Merry Christmas to all 2 of you still reading out there, may your holidays be Merry, Bright, and Doom Free! :)

Friday, September 23, 2011

She's Complicated

A commenter from the post below states that I'll not likely elicit sympathy by stating that women can be difficult patients, who require significant amounts of communication. The question is also raised why I would "generalize" 100% of my patient population, as surely, if there were no women to treat, I could no longer be an Ob/Gyn (sic). I find it overall amusing that anyone would believe the post below was written, in any way, to garner sympathy, and I also find it a bit irksome to be told that I "shouldn't generalize." I'm not. I am speaking from my own personal experience. Perhaps I should expound upon this point.

I went into Obstetrics and Gynecology precisely because I enjoy caring for the(complicated, difficult) female patient. I would not do anything else, but I would be absolutely lying if I said it wasn't without its difficulties. For the record, I happen to find male patients, no offense guys, infinitely more simple in many ways, but less likely to follow any directed care of a physician unless there is fear of loss of life or, ahem, other *important* functions. In my interactions with male patients, there was little extraneous conversation, merely exam, diagnosis, suggestion for treatment (which they may or may not decide to take, but they certainly weren't going to ask you any questions about it). Women patients, quite simply, are different. They do require a lot more communication; not just about the reason for certain symptoms that they may be feeling, but also for the rationale behind the treatments to alleviate the symptoms.

Usually, this is not a problem for me, being a woman myself, particularly verbose ("talks too much" was a very popular comment on my report cards sent home from school), and, not to mention, I happen to like explaining physiologic changes in a way that women can understand and to which they can relate. However, sometimes something as relatively facile as communication can cross the line. At times, it can be repetitive and monotonous (likely not so different from other jobs). At other times, I feel as though I am speaking a script, word for word. Sometimes, it can be frustrating (for both the patient and myself), because no matter how I frame the explanation, I cannot communicate my point. Most of all, it can become emotionally draining. Women routinely tell me things that would feasibly make most people's ears burn, make me worried for them, and sometimes bring me to the brink of tears. I have an impeccable poker face, but over time the walls get chipped away and I find myself unable to stop bringing my work home with me.

I suppose it is a good thing to be human, but in medicine it is important to remain detached in order to stay objective and to provide good care. It is a difficult balance between being connecting with the patient without becoming emotionally *involved* with the patient. This is difficult and soul-grinding, especially for those of us who have a tendency to try to "fix" people. It is a burden I more than willingly shoulder every. single. day, but honestly connecting with patients can be good for them and harder for me. I'm not willing to stop doing it, but to say that it shouldn't affect me emotionally is far more presumption than I would have the wherewithal to make from the outside looking in. In summation, saying that women are "difficult and complicated" patients is not meant as an insult or to "generalize" women, it is simply a statement that I find to be true, not only of my patients, but of myself, as well.

Sunday, September 11, 2011

Ten Years

Ten* years ago today, I was a harried and hurried OB/GYN intern, the only intern on the OB floor. Rounds ran long because of a long patient census, and we were late getting over to Labor and Delivery to "run the board" (aka, check on the laboring patients). I had four laboring patients, three patients to see in OB triage, and a 30 week pregnant woman just involved in an MVA on the way into the ER. I was just about to check on my first labor patient when the charge nurse came out of a patient's room. "A plane just crashed into the World Trade center!" The sarcastic comments followed, ranging from jokes about air traffic control to what substance the pilot was smoking. It mildly piqued my interest, but to tell the truth, I hadn't the time to sit and ponder the significance. I was halfway through my triage and labor checks when the second plane hit. Then, we knew, this was no accident, and I, like everyone else that day, was scared about what this meant. Ever in constant motion, I caught what updates I could from the patient's TV screens, as I went about the routine business of histories and physicals on a most unusual and frightening day. My chief resident and I went together to see the MVA patient, it was merely a fender-bender, no real trauma, and we hooked her up to the labor monitor to look for contractions. She gasped, suddenly, eyes wide in disbelief, locked on the television mounted on the wall in the corner of the room. My chief and I turned, to see the mighty towers collapsing into dust and rubble. I don't know how long we sat and stared, silent.

The rest of that day is a true blur. I delivered eight babies between 9 am and 5:30 pm that day, four inductions and four natural labors. I distinctly remember one young patient, just 17, crying after the delivery, not tears of joy or even pain from labor, but of sadness and terror. I couldn't help but think that the baby boom that day was simply a surge to replace the souls so tragically lost. I think the unit had a total of 11 deliveries that day. This year, they are 10 years old, nearly ready for 5th grade. In the days that followed, I was morbidly fixed to the TV and the news. My husband couldn't tear me away. I couldn't stop watching. It lasted for about 3 months, and then the shock was not nearly so fresh, and I could watch non-news programming once again. Five years ago, my husband was attentively watching the commemorative movie on television. I have no desire to see any films about that day. I didn't understand why five years was the magical number for it to be permissible to start turning a profit on such a terrible day in our lives and the lives of the victims. I could barely sit through the previews of United 93 without bawling. I don't need a reminder of the tragedy, as it is indelibly burned into my memory. I was fortunate that I did not lose a loved one or a close friend, and for that I am grateful. But we as a nation suffered the loss of, not only the lives of the victims and the heroes of that day (in itself a staggering loss), but the loss of life as we had so complacently come to know it. We lost innocence and we lost feeling secure, and I'm not sure that we will ever feel the same way as we did ten years and one day ago. Today, I, like so many of you, will ponder in silence and return to the day when we knew things would never be the same. Today I will remember to never forget.

*Originally posted on 9/11/06